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i <br /> Intake & Approval Sheet 0 (FOR PERMIT STAFF ONLY) PERMIT# 1 Y ► Q" O `'U 15 <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: at Assign To: t ttiA4 Date: 2-/47220 <br /> Intake Comments: Intake Comments: <br /> El Route to Commercial Building 0 Attach to Project No. <br /> ❑ Route to Residential Building ❑ ute to Historic Reviewer <br /> ❑ Make this a"W"Permit OK to Route to Other Departments <br /> Bldg/TI/Addn/Rem Size ❑ Hold in Planning File Drawer <br /> Garage/Accessory Struct.Size Zone MA)0 <br /> Number of Stories Overlay/Agreement <br /> Basement ❑No Oyes , Fin/Unfin Nonresidential Use <br /> Type of Construction Residential Use <br /> Occupancy Group Proposed No.of Dwelling Units: <br /> Occupancy Load Total No.of Dwelling Units: ' <br /> Fire Sprinklers: Existing ❑New System ❑Not Req'd Planning/Landscape Inspection Required before Final? ❑Yes r I. <br /> Reason Sprinklers Required: "In Lieu"Few: pe: unt$ <br /> Fire Alarm: ❑Update Existing ❑New System ❑Not Req'd School Impact Fee: o <br /> Reason Fire Alarm Required: Calculated: it: <br /> RCW 64:55 MF worksheet req'd for permit? Oyes ❑ No DEverett S o Dist ❑Mukilteo School ' <br /> Add'I RCW 64.55 docs required prior to final? ❑Yes ❑No Additional Notes: <br /> VALUATION CALCULATION: Total $ w0Z Ob <br /> Approved By: Q Date:211/242_0 <br /> PUBLIC WORKS <br /> Intake OK by: Date: - <br /> Additional Notes: Intake Comments: PW Worksheet Needed if: <br /> ❑Sys Dev Eval ❑Traffic Mit Eval <br /> =DSite Work or Drainage Proposed <br /> Approved By ,,,�/ Date:OZ/p� OZo =�Bal, flow Prevention for high hazard: <br /> / (dental,medical,animals,mortuary,hospital, <br /> :supportive housing) <br /> FIRE DEPARTMENT ❑Route this folder for PW Review at end ---PW Review Worksheet <br /> Separate/Deferred Submittals Required: ❑This project also has a separate concurrent PW Review(Green Folder) <br /> El Fire Sprinklers ❑Fire Alarm ❑Other: AND El Create Green Folder ❑Submitted Previously ❑Deferred <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑ See PW Review Worksheet and associated attached items <br /> Fire Dept. Fees: ❑ A Separate PW Permit is Required(Permit#: PW ) <br /> ❑ Review of As-Built Plans-NO FIRE FEE AND ❑ Is located in this folder <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE ❑ Is in a Separate Green Folder(join with this folder for permit issuance) <br /> ❑ Review/Inspection Scope-ADD FIRE FEE ❑ Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Approved By: Date: Public Works has no sco ---PW Not Required <br /> Additional Notes: <br /> ELECTRICAL <br /> Additional Notes: <br /> Approved By: Date: Approved By: Date: <br /> Z12____ <br />